Florida Medicare Telephone reopening requests via the IVR
Medicare Part B interactive voice response (IVR) allows providers/customers to request telephone reopenings on certain claims.
• This enhancement is designed to make your requests easier and faster to process. Requests for telephone reopenings via the IVR will process the next day.
• Using this self-service feature will result in faster receipt of any applicable payments.
• The hours of availability are beyond the hours of availability for a customer service representative (CSR).
• IVR reopenings will be limited to simple, single-line requests.
• Bonus — The number of telephone reopening requests via the IVR are unlimited within the allotted 30-minute time frame.
Types of reopenings available via the IVR
The following types of reopening requests are not available through a CSR; you must call the IVR for the following types of requests:
• Change date of service on paid claims (history corrections)
• Change diagnosis code
• Add, delete, change modifier (except modifiers listed below)
• Claims containing single detail lines (except requests to add modifier GV or GW to multiple-line claims for a beneficiary enrolled in hospice)
• Entitlement, Medicare Secondary Payer or Medicare Advantage Plan change in status
Types of reopenings that cannot be performed via the IVR
You may continue to speak with a CSR to request a telephone reopening for types of reopenings not available through the IVR.
• Previously adjusted claims
• Claims containing multiple detail lines (except hospice modifiers GV or GW or Entitlement reopenings)
• Pending claims
• Non-assigned claims
• Drug and drug administrations codes
• Request on claims containing the following modifiers, or requests to add or change these modifiers: 21, 22, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU.
Information you must have when calling the IVR for a reopening
• Provider’s National Provider Identifier (NPI), Tax Identification Number (TIN), and Provider Transaction Access Number (PTAN)
• Beneficiary’s last name and first Initial
• Beneficiary’s Medicare health insurance claim (HIC) number
• Beneficiary’s date of birth
• Caller’s name and 10-digit telephone number (3-digit area code and 7-digit number)
• Date of service
• Internal Control Number (ICN) — can be obtained from your provider remit notice or the IVR when receiving a claim status
• Item(s) or service(s) at issue
• Reason for request
• New/revised information
IVR takes your request — what’s next?
• IVR will confirm the request at the end of the call.
• If the request is approved, you will receive a letter and new remittance advice notice.
• If the request cannot be processed, a letter will be sent advising the provider of our decision.
• If the request would create an overpayment situation, the IVR will advise you to submit your request via a written redetermination form.
IVR hours of availability for telephone reopenings
• The IVR is available for requests for telephone reopenings from 7:00 a.m. to 6:30 p.m. Monday through Friday, and Saturday 7:00 a.m. to 3:00 p.m. ET.
• The toll-free Part B telephone number is 1-877-847-4992
• No limit to the number of calls per day.
• Please have the information listed under “Information You Must Have When Calling the IVR for A Reopening” available when calling for an IVR reopening.
• If you are calling to perform an adjustment on multiples lines or on a claim with multiple issues, please call our customer service center at 1-866-454-9007 for providers in Florida and the U.S. Virgin Islands, and 1-877-715-1921 for providers in Puerto Rico.
• Additional IVR instructions are available via our IVR Part B operating guide.
To ensure you have all the information needed to submit your reopening request(s) via the IVR, we suggest using the IVR reopening request help sheet when preparing to call the IVR.